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Editor's note: This is the second in a three-part series about efforts to improve the condition of downtown Juneau. Part three, which will focus on past and current efforts to improve downtown's buildings and environment, will appear in the July 30 issues of the Juneau Empire and Capital City Weekly.
Urban Decay, Part II: First comes housing 072314 NEWS 1 Capital City Weekly Editor's note: This is the second in a three-part series about efforts to improve the condition of downtown Juneau. Part three, which will focus on past and current efforts to improve downtown's buildings and environment, will appear in the July 30 issues of the Juneau Empire and Capital City Weekly.

Michael Penn | Juneau Empire

A row of tents covered with traps line an area near Thane Road and downtown Juneau in November 2009. The land, which belongs to AEL&P, regularly hosts camps of homeless Juneau residents. This camp was torn down by AEL&P soon after this picture was taken, but homeless people still live in the area.

Wednesday, July 23, 2014

Story last updated at 7/23/2014 - 4:22 pm

Urban Decay, Part II: First comes housing

Editor's note: This is the second in a three-part series about efforts to improve the condition of downtown Juneau. Part three, which will focus on past and current efforts to improve downtown's buildings and environment, will appear in the July 30 issues of the Juneau Empire and Capital City Weekly.

•••

It costs millions of dollars for Juneau to leave its chronically homeless, chronically inebriated residents to sleep under bridges and in the woods.

Those who work with Juneau's less-fortunate population have been moving toward a housing-first solution called permanent supportive housing. The philosophy is simple: Once the homeless have homes, it's easier to tackle the problems that made them homeless in the first place - addiction, poverty, alcoholism or mental illness. Even from a purely economic perspective, it's something the average Juneau resident should get behind, they say. Though it may sound costly to house and care for those who are chronically homeless and suffering from drugs or alcohol addictions, it actually costs much less than not helping them until they're taken to Lemon Creek Correctional Center, Bartlett Regional Hospital, Rainforest Recovery Center, or another place.

As it is now, says Jennifer Brown, who is both program director of Rainforest Recovery and director of Bartlett's Mental Health Unit, the chronically homeless spend too little time at Rainforest to properly deal with their addiction. Many "sleep it off" in the facility multiple times per month.

"It seems like we have them such a short time to treat them and to stabilize them, and it almost feels like we send them back out to a situation where it's a big set up for failure and relapse," Brown said.

Unless they're Juneau Alliance for Mental Health Inc. clients, they don't usually have a caseworker to help them with their issues once they leave, she said.

"We can't expect people to be successful if they aren't feeling safe and don't have the tools to meet their basic needs," Brown said.

Some of the Juneau Coalition on Housing and Homelessness' progress in the last few years is in understanding the population it's dealing with, said Scott Ciambor, chairman of the Alaska Coalition on Housing and Homelessness. Like Brown, Ciambor wears multiple hats: he's also a planner for the Alaska Mental Health Board.

"The coalition has been great about doing the point in time count, Project Homeless Connect, and finding out what the situation is for the homeless population here in Juneau, to the point we're having a very concrete discussion about a subset of the homeless population," he said.

Juneau Police Department spokesman Lt. David Campbell said he thinks permanent supportive housing is "a fantastic idea."

"I was a cynic at first but ... I have seen research, and think it could have a profound effect in Juneau," Campbell said.

"If we can really move and tackle the permanent supportive housing project, we'll see some real successes," Ciambor said.

Vision

Permanent supportive housing is exactly what it sounds like. It's permanent - residents can stay as long as they like.

It's supportive, meaning a case manager, nurse or other staff member will help residents with issues they may face. Most of the time, those case managers catch problems before they're problems, Ciambor said.

And of course, it's housing.

Unlike the downtown shelter and soup kitchen The Glory Hole, which requires residents to have a blood alcohol content of less than 0.1, permanent supportive housing is housing first. Residents wouldn't be required to stop drinking, though they'd be encouraged to. That encouragement tends to be successful, Ciambor said.

The facilities are also sometimes called permanent supported housing, but not, as was written in Part I of this series, permit supportive housing.

For ideas about who a Juneau facility would house, Ciambor looks to the Juneau coalition's vulnerability index, which indicates residents would be older, on the streets for a long time (9 ½ years, on average), have many physical needs, and have mental health problems, he said.

More than half of those surveyed worked officially or under the table, more than half were Alaska Native, and many were veterans.

In order to be designated vulnerable - 40 of the 55 people surveyed were - a person must have a substance addiction, a mental illness, and a major health problem. All three mean a person is three to four times more likely to die on the streets, Ciambor said.

"It's a really traumatized subpopulation (of the homeless). People like the fact that we're an isolated community, but for this population, that's such a detriment. If we don't have the proper style of housing, it doesn't exist, so they're fending for themselves, really," Ciambor said.

Two years ago, Ciambor and representatives from the city and borough of Juneau, Tlingit-Haida Regional Housing Authority, JAMHI, Alaska Mental Health Trust Authority and the Juneau Police Department visited two housing first facilities in Michigan. They found that as residents' health improved, their negative behaviors decreased and they stabilized. They had more time and inclination to work and improve relationships.

Soon after a facility was established in Duluth, Mich., the police stopped driving by twice an hour, as they'd been requested to, Ciambor said. The checks weren't needed.

In another story that stood out to Ciambor, soon after that facility got going, people in the general public started making frantic phone calls, wondering where the homeless had gone. They thought someone had taken the homeless away: In reality, they were housed, and busy.

"Pretty much everybody came back with the feeling we really need to pursue this type of project," Ciambor said.

Ciambor anticipates the facility would include between 25 to 40 units, with staff at the one point of entry, cameras, case managers, and a nurse.

As to where it would go, that could be anywhere with bus access, at this point, though there's general consensus is that it would be best not to have it "in the downtown corridor," Ciambor said.

Seventy-three percent of Juneau's vulnerability index respondents said they'd like to live in a permanent supportive housing facility.

Existing facilities

Anchorage started its Housing First facility, Karluk Manor, in December 2011. At the time, it was controversial.

Two years later, tenants are drinking less, going to the emergency room less, and being picked up by the police less, the Anchorage Daily News (now Alaska Dispatch News) reported in December. At $22,000 per year, per person, they cost the city a little more than a third of what they did on the streets, and Anchorage Mayor Dan Sullivan is now pushing to expand the project.

Permanent supportive housing isn't a new concept in Juneau; JAMHI has it, as does REACH Inc., Ciambor said. What would be new to Juneau is the population it would serve.

JAMHI considers affordable housing a prerequisite for its clients' recovery.

JAMHI Executive Director Pam Watts said if not for the organization's housing, some of its clients might otherwise be homeless.

"Often people with serious mental illness find themselves homeless," Watts said. "They may or may not have a co-occurring substance use disorder or a cognitive impairment that contributes to their homelessness."

"I view both conditions (chronic inebriation and mental illness) as disabilities," said St. Vincent de Paul director Dan Austin.

Though St. Vincent shelters the homeless in a transitional living facility, the majority of its clients are homeless due to economic circumstances, he said.

Million-dollar Murrays

Juneau has about 25 to 30 "million-dollar Murrays," Ciambor said.

"Million Dollar Murray" is a term that comes from a Malcolm Gladwell essay about homelessness. The essay featured a lovable chronic inebriate named Murray, who did well under supervision, but fell back into unhealthy habits without it, eventually dying.

His recurring treatment and emergency services were estimated to cost more than $1 million over 10 years.

In Juneau, those services also add up.

Ciambor looked at 10 chronically homeless Rainforest Recovery clients in Juneau over the course of two months. In both months, they had a combined 153 Rainforest Recovery and 67 emergency room visits.

The total estimated cost to care for the 10 people for just two months was $155,928.

"It's extremely expensive, and I think the big thing is it's nobody's responsibility," Ciambor said.

"I think we're reaching that critical mass stage where the impact of this relatively small population - you're talking about maybe 25 to 30 individuals who if we could get off the street and into some kind of permanent supportive housing - the impact of getting those 25 people off the street ... for the rest of the community is immense," Austin said. "When you look at the impact that population has on the local business, the impact they have on our tourist industry... and public health costs - it's in everybody's self interest that we get these folks off the street and into some sort of more humane and safer and supervised housing."

Moving forward

The project will likely be funded from a variety of sources - state, city, federal, nonprofit and private.

"The foundation is there and the model is there," Brown said. "I think we need to get support from the city and buy in from agencies and, again, funding, to make this a reality."

One of the main sources of funding likely will be an Alaska Housing Finance Corporation special needs grant. Advocates are waiting to see what the procedure will be this year, Ciambor said.

Other primary sources of funding will likely include grants from the Alaska legislature, Rasmuson Foundation, an Indian Community Development Block Grant, the Juneau Affordable Housing fund, and other sources.

Much of the project funding may need to come from the community, Ciambor said, citing a study which found projects needed around eight funding sources to be completed.

Once it was established, the facility wouldn't be free. Like JAHMI's, it would charge rent on a sliding scale. Many residents would qualify for Native corporation dividends, disability payments, Medicaid and Medicare reimbursements, housing vouchers, Social Security, and, of course, for the Permanent Fund Dividend. More than half also have some kind of job, and employment is something case managers would help them with.

Ciambor declined to give a cost estimate at this point, saying it depends on specifics of the project that haven't yet been decided. Whatever the case, however, it's bound to be cheaper in the long term than not doing anything, he said.

Glory Hole executive director Mariya Lovischuk has said she thinks moving the Glory Hole, which some think may be a solution to some of downtown Juneau's problems, would cost about the same as building permanent supportive housing for Juneau's chronically homeless.

Austin places his faith in Juneau itself.

"We'll get this thing done at the local level," Austin said. "It isn't going to come from HUD, the federal government, the Legislature, an agency in Anchorage. It's going to come from the local people. We'll get our priorities straight."

While Ciambor lists the Rural Alaska Community Action Program (RurAL CAP, which developed Karluk Manor) JAMHI, Rainforest Recovery, and Tlingit-Haida Regional Housing Authority as primary partners, it remains to be seen who will take the lead, he said.

This year's Alaska Coalition on Housing and Homelessness conference will be from Sept. 29 to Oct. 1 in Juneau, and will feature guest speakers Sam Tsembaris and Bill Hobson, both experts on supportive housing.

"The working group is really comfortable where we are knowing that this is the solution. This is what is needed," Ciambor said. "It's a matter of (taking) the steps to get there."


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